Progress Made, Challenges Ahead: A Black History Month Address from Hon. Donna Christensen
As this Black History Month draws to a close and those of us in health care take time to honor those whose work laid the foundation for health equity, we are compelled to assess how much progress has been made. We cannot deny that there has been movement, but the pandemic revealed just how superficial that progress has been.
To achieve health equity and eliminate disparities in access and health status requires a far deeper dive. The wide-spread activism we saw after too many police killings, the undeniable reality of inequity laid bare by the pandemic, and a new administration committed to bipartisanship and dedicated to equity and justice certainly gave us hope that it would happen.
We knew, despite the strong winds at our backs, it would not be easy. One early indication of this was a finding in our own research — one that could have been easily overlooked. In our 2021 Consumers for Quality Care survey, 75 percent of respondents acknowledged that a disparity in health care exists between people of different income levels, yet far fewer (50 percent) said that a disparity existed based on race and ethnicity. That this ignorance of the stark and longstanding realities of unequal access to quality and comprehensive health care still existed in 2021 was a clear message of the uphill battle we face to reach health equity in America — a country with all the knowledge, technology, and medical advancements to achieve it.
In addition to a deeper dive, we need a new paradigm rooted in a clearer understanding of the root causes of the health disparities that African Americans, Native peoples, and other communities of color suffer and die from in excess numbers every year.
For too long, the onus for our health has been put on the people and communities that have suffered under the disproportionate burden of disease. While we all must accept some degree of personal responsibility for our own health, it is time for the “system” to accept its duty to ensure that health care is a right for everyone in this country and that all people — regardless of race, ethnicity, or income level — have access to the quality, affordable health care they need.
To effect real and sustainable change in the health of every community and demographic, we have a responsibility to ensure that their living and working environment is such that it supports health and wellness. The social, economic, and environmental determinants of health must be addressed and racism and discrimination in health care and all other facets of life must be eliminated. Equity will never be achieved otherwise.
Yes, there must be affordable and reliable insurance and full Medicaid expansion, and people of color must have adequate access to hospital services and other providers, but there are a number of factors which must be considered:
People of color cannot be healthy if they are more likely to live in areas where pollution is high, and where they are at higher risk for the adverse impacts of climate change. Future generations of African Americans have even more to worry about; More than half of African Americans live in the South, which will see more increased natural disasters, hurricanes, and flooding as a result of climate change.
We cannot be healthy if nutritious foods are not within reach. Food insecurity, or a lack of consistent access to enough food for a healthy lifestyle, disproportionately targeted African Americans and other racial minority groups.
We cannot be healthy if our communities are bombarded with alcohol and cigarette advertising and where both are more accessible than fresh fruit and vegetables. In 2009, African American youth witnessed 32 percent more alcohol ads in magazines and 17 percent more on television than American youth overall.
We cannot be healthy if segregation limits access to needed services and locks generations into poverty because of the lack of economic opportunity. African Americans are the poorest ethnic group in America with the lowest median household income and the least resources available to them. Additionally, Residential segregation has led to a lack of hospitals and primary care providers in majority African American areas.
It is hard to be healthy when education systems in communities of color are underfunded, understaffed, and under-equipped — leading, inevitably, to inequity. The Black male youth is less likely to participate in AP courses, less likely to participate in magnet programs, and more likely to attend a school with few resources. These substandard K-12 education system in communities of color are not producing doctors and other health care providers that share the race, ethnicity, language and culture with us. Providers that look like us help to build the trust that is fundamental to our relationship with the health care system. Racial minorities are more likely to choose medical professionals of their own race. Alarmingly, African Americans account for 12.6% of the US population, but only 4.4% of the medical field. This is not by chance. We are not giving African American youth the resources and support to achieve medical careers.
It is impossible to be at our optimal health when faced with ongoing — and now increasing — racial trauma that damages our physiology and even our genetics, making us more susceptible to chronic disease, disability, and mental illness. The duration of the trauma is directly proportional to its impact, thus affecting this country’s indigenous populations (American Indians, Native Alaskans, and Hawaiians) and those of us of African descent the most.
In a country where there is an increasingly unhealthy relationship to the truth and where the lies are directing increasing animosity against people of color, the work toward health equity will be harder than ever. But the history we have just revisited this Black History Month should be all the inspiration we need to overcome any obstacle put before us, just as generations before us have done.
The Honorable Donna M. Christensen is a member of the Consumers for Quality Care board. She retired in 2015 from the U.S. House of Representatives, where she served nine terms. She is the first female physician to serve as a member of the history of the U.S. Congress.